Hallux valgus is the commonest forefoot deformity, with an estimated prevalence of 23% to 35%. It causes symptoms on the medial edge of the foot, the sole, and the small toes. Non-operative treatment may alleviate symptoms but does not correct the deformity of the big toe. Surgery is indicated if the pain persists. The correct operation must be selected from a wide variety of available techniques.

Hallux valgus causes symptoms in three particular ways. First and foremost is pain in the bunion, the pressure-sensitive prominence on the medial side of the head of the first metatarsal. It hurts to wear a shoe. Furthermore, the valgus deviation of the great toe often results in a lack of space for the other toes. They become displaced, usually upwards, leading to pressure against the shoe. This is termed hammer toe or claw toe. Finally, normal function of the forefoot relies heavily on the great toe pressing down on the ground during gait. Since the valgus deformity stops this happening to a sufficient degree, metatarsal heads II–V are overloaded. The resulting pain is referred to as transfer metatarsalgia.

Conservative treatment

Only while the skeleton is still growing can the position of the great toe be improved with lasting effect. A night splint can be prescribed to move the great toe to medial. After the end of growth, adequate correction is no longer possible and conservative treatment is restricted to alleviation of symptoms.

By the time patients consult a physician, most of them have already resorted to softer and wider shoes to alleviate pain from pressure on their bunion. Ring pads and other dressings tend to increase the prominence of the bunion and are usually unsuccessful. Antiphlogistic salves can be administered locally, nonsteroidal anti-inflammatory drugs systemically.

Pain in the smaller toes can be alleviated with pads and toe straighteners. Wide, soft shoes are helpful if they give the toes enough space. Once hammer toes or claw toes have developed, however, surgery is necessary.

In our experience, insoles are effective for alleviation of metatarsalgia. They must feature a pad that pushes the metatarsals upward proximal to the pressure-sensitive heads. It often suffices to advise the patient to wear shoes with soft soles and without excessively high heels (no more than 4 cm). The malposition of the great toe, of course, cannot be corrected with insoles alone.